povidone-iodine and Aortic-Aneurysm--Thoracic

Infection of an ascending aortic prosthesis is a grave complication associated with a high mortality. In most cases, extraanatomic bypass and removal of the infected vascular graft are not possible. Furthermore, the standard approach to this problem, which includes excision and replacement or debridement and repair of infected thoracic aortic grafts, carries a high early mortality. We report the successful treatment of this life-threatening complication using a conservative strategy in which the aortic prosthesis was salvaged by in situ disinfection followed by coverage with tissue flaps.

Topics: Adult; Aortic Aneurysm, Thoracic; Aortic Dissection; Blood Vessel Prosthesis; Humans; Male; Mediastinitis; Povidone-Iodine; Prosthesis-Related Infections; Proteus Infections; Proteus vulgaris; Reoperation; Surgical Flaps; Surgical Wound Infection; Therapeutic Irrigation

Mediastinitis is one of severe and fatal complications after cardiac surgery, especially in the presence of a prosthetic graft. A 70-year-old male, who was suffered from chronic sternal osteomyelitis and mediastinitis after ascending aorta and hemiarch reconstruction was reported. He developed high fever and leucocytosis on the 16th postoperative day. Wound culture was positive for Grampositive organisms. He was diagnosed as having sternal osteomyelitis and mediastinitis and treated by sternal bone debridement and irrigation with dilute povidone iodine solution with no effects. Total excision of the infected sternum, irrigation with non-diluted solution of povidone iodine and omental transfer were performed successfully. The literature regarding omental transfer for mediastinitis and infected prosthetic grafts was briefly reviewed.

Topics: Aged; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Chronic Disease; Humans; Male; Mediastinitis; Omentum; Osteomyelitis; Povidone-Iodine; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus epidermidis; Sternum; Therapeutic Irrigation